The saddest thing have learned in my 33 years as a member of our community is that the greatest obstacle I have faced in following Christ has not come from the world, but from the efforts of fundamentalist extremists both to make a tendentious and highly selective reading of our community's views on Genesis normative for everyone, and to make one of the best attested scientific facts a 'doctrine to be rejected.' I've written many times on how 'nothing in medicine makes sense except in the light of evolution'. [1] This isn't hyperbole. Human anatomy, genetics, and embryology positively shout the fact of our evolutionary origin, while evolutionary biology is of increasing utility in areas such as infectious diseases, epidemiology, and cancer biology. Pretending that evolution is not a fact for me is no more an option than pretending that the Earth is flat, or that the sun revolves around the Earth.
I was reminded yet again of the incredible utility evolution has for medicine in a recent article [2] at the Panda's Thumb blog reporting on a new book, Adaptive Oncogenesis: A New Understanding of How Cancer Evolves inside Us (2018: Harvard University Press) by by James DeGregori, a professor in the Department of Biochemistry and Molecular Genetics at the University of Colorado School of Medicine, who is also the Deputy Director of the University of Colorado Cancer Center. The Panda's Thumb article is adapted from the book's introduction, so for those who want more, as he says, the best thing to do is to buy it. However, the closing paragraph of the post is enough to convey why DeGregori regards evolution as fundamental to understanding cancer:
This book will reevaluate clinical data within the adaptive oncogenesis framework, providing explanations for why cancer occurs in young children and why the detection of oncogenic mutations far outpaces incidence rates of cancers. It will discuss evolutionary theory‒based strategies to modulate tissue microenvironments as a way to control the fate of precancer and cancer cells, and thus to prevent and treat cancers. The reductions in cancer mortality after almost half a century of the war on cancer have been real but disappointingly inadequate. Greater focus on tissue landscapes and how they affect the evolutionary dynamics of both noncancer and cancer cells may be necessary to limit the pernicious impacts of this disease. All of these discussions will be framed in the light of evolution, as urged by the great evolutionary biologist and geneticist Theodosius Dobzhansky. For better or worse, we and all other animals are products of the forces that shaped our evolution. Thus, we will start with an understanding of life histories among different animals, and how and why they evolved.
Fascinating, but not only is this not the first time I have blogged on evolution and medicine, it is not even the first time I have commented on evolution and cancer biology. This is not merely a reflection of my personal interest in tumour biology and cancer. Searching the literature shows that this is a productive area of medical research. [3-5] As Joshua Swamidass, Assistant Professor of Laboratory and Genomic Medicine at Washington University reminds us:
We have some understanding of cancer evolution, but we are learning more all the time. Currently, we have the genomes of over 10,000 tumors, covering dozens of different types of cancer, and this number is going to exponentially grow in coming years. Repeated observations of the same evolutionary process gives us unprecedented understanding of how life evolves.As for the larger picture, I have repeatedly pointed out how the evidence from comparative genomics and evolutionary genetics alone confirms both the fact of human-ape common ancestry, and the reality of the fact human existence stretches back well before the earliest possible date for Adam. Even for a generalist like myself, remaining ignorant of this or pretending that it does not exist is simply not compatible with being both a competent medical professional or to be blunt, an intellectually honest person.
In the end, cancer does not (usually) demonstrate evolution of new species. It does not demonstrate that humans arose from a common ancestor with the great apes. It does not demonstrate the full story of evolution. To tell that story, we need information from the genomes from multiple species and the fossil record. Encouragingly, the same evolutionary theory that reconstructs cancer’s history works here too.
Even before engaging the larger story, a detailed look at cancer leaves us with some important conclusions; without doubt, evolution makes sense of cancer. Whether or not we agree with the full evolutionary story, cancer demonstrates that evolutionary theory itself is useful. Going a small step farther, understanding evolution is centrally important in medical research. Fundamentally, cancer is an evolutionary disease. It only arises because life evolves. [6]
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Glioblastoma multiforme histology. GBM is one of the most aggressive primary brain tumours
I started this post by reflecting on the sad fact that in my experience, fundamentalist intolerance was by far the biggest problem to following Christ that I have encountered. My experience is not atypical. As I've noted many times, in its research into why young Christians abandon their faith, the Christian market research firm The Barna Group found that science denialism was one of the six reasons why nearly 60% of Christians aged 15 and over left their faith:
One of the reasons young adults feel disconnected from church or from faith is the tension they feel between Christianity and science. The most common of the perceptions in this arena is “Christians are too confident they know all the answers” (35%). Three out of ten young adults with a Christian background feel that “churches are out of step with the scientific world we live in” (29%). Another one-quarter embrace the perception that “Christianity is anti-science” (25%). And nearly the same proportion (23%) said they have “been turned off by the creation-versus-evolution debate.” Furthermore, the research shows that many science-minded young Christians are struggling to find ways of staying faithful to their beliefs and to their professional calling in science-related industries. [7]While I have found intellectually, scientific, and theologically honest ways of remaining faithful to my beliefs and my professional calling, I am aware of many who have found parts of our community actively hostile when trying to remain faithful both to their faith and their calling. In fact, they have been forced to make a choice between fundamentalist science denialism and the worship of tradition masquerading as faith and the witness of God's creation to an ancient, evolving Earth. Over fifty years ago, W.F. Barling, writing at the height of the hysteria surrounding Ralph Lovelock's attempt to reconcile his faith with then then-already compelling evidence for human evolution noted:
Meantime, what they seek is not approval but tolerance. If a repudiation of the notion of slow change as God’s method of creation is demanded of them, then their loss to the community is inevitable. So too, alas, is the loss of many potential candidates for baptism who share their perplexity and, feeling that the Brotherhood will not tolerate them with their mental reservations, are being driven, in their desire to give themselves to Christ, more and more towards evangelical groups with less exacting theological demands to make on their converts than we have. [8]If fundamentalist intolerance prevails, then our community not only will drive out its best and brightest in the inevitable purge, but will make it utterly unattractive to potential converts, and end up becoming a marginal, decaying, irrelevancy of absolutely no use to God. As Augustine noted over 1500 years ago:
Now, it is a disgraceful and dangerous thing for an infidel to hear a Christian, presumably giving the meaning of Holy Scripture, talking nonsense on these topics; and we should take all means to prevent such an embarrassing situation, in which people show up vast ignorance in a Christian and laugh it to scorn. The shame is not so much that an ignorant individual is derided, but that people outside the household of faith think our sacred writers held such opinions, and, to the great loss of those for whose salvation we toil, the writers of our Scripture are criticized and rejected as unlearned men. [9]
References
1. I wish I could say I was the first to come up with this obvious allusion to Dobzhansky's famous paper, but there exists an (excellent) 2012 paper with this title in the Journal of Molecular Medicine
2. James DeGregori "How cancer evolves within our bodies" The Panda's Thumb May 18 2018
3. Matias Casás-Selves and James DeGregori "How cancer shapes evolution, and how evolution shapes cancer" Evolution (2011) 4(4): 624–634.4. Beata Ujvari, Benjamin Roche, Frédéric Thomas (Eds) "Ecology and Evolution of Cancer" (2017: Elsevier
5. Angelo Fortunato et al "Natural Selection in Cancer Biology: From Molecular Snowflakes to Trait Hallmarks" Cold Spring Harb Perspect Med. 2017 Feb 1; 7(2): a029652.
6. S. Joshua Swamidass Cancer and Evolution BioLogos Blog January 11, 2017
7. Six Reasons Young Christians Leave Church Barna Group September 27, 2011
8. Barling W.F. "Letter: The Origin of Man" The Christadelphian (1965) 102:463–464.
9. https://www.ancient.eu/article/91/st-augustine-from-the-literal-meaning-of-genesis/
